THE SOLVE-TAVI trial demonstrated that both valve type and anaesthesia strategy yielded comparable long-term outcomes in transfemoral TAVR, with notable differences in specific clinical measures.
This randomised, multicentre, open-label study followed 447 patients with severe, symptomatic aortic stenosis over five years after undergoing transfemoral transcatheter aortic valve replacement (TAVR). Patients were assigned to second-generation self-expanding valves (SEV) or balloon-expandable valves (BEV) and to conscious sedation (CS) or general anaesthesia (GA) in a 2 × 2 factorial design. The primary endpoint was a combined measure of all-cause mortality, stroke, moderate or severe paravalvular leakage, and permanent pacemaker implantation for valve comparisons, and all-cause mortality, stroke, myocardial infarction, and acute kidney injury for anaesthesia comparisons.
The analysis revealed no significant differences between SEV and BEV in the primary endpoint (67.7% vs 63.4%; HR: 0.89; 95% CI: 0.70-1.13; P = 0.34). However, stroke rates were significantly lower in the SEV group (2.2% vs 9.6%; HR: 4.84; 95% CI: 1.65-14.18; P = 0.002). For anaesthesia strategies, the primary endpoint occurred in 51.4% of CS patients versus 61.3% of GA patients (HR: 0.80; 95% CI: 0.62-1.04; P = 0.09). Importantly, all-cause mortality was lower in the CS group (41.5% vs 54.3%; HR: 0.70; 95% CI: 0.53-0.94; P = 0.02).
The findings suggest that valve type (SEV vs BEV) and anaesthesia strategy (CS vs GA) result in similar long-term outcomes using a combined clinical endpoint, though conscious sedation and SEVs may offer specific advantages. For clinical practice, conscious sedation should be considered for its potential mortality benefits, while SEVs might reduce stroke risk. Future studies should explore underlying mechanisms and refine patient selection for optimised outcomes in TAVR.
Katrina Thornber, EMJ
Reference
Feistritzer HJ et al. Effect of valve type and anesthesia strategy for TAVR: 5-year results of the SOLVE-TAVI trial. Journal of the American College of Cardiology. 2025;85(1):74-82.
